Antibiotics in Early Life: What Are We Changing for the Future? w Prof Wayne Cutfield

We’re joined by Wayne Cutfield, a paediatric endocrinologist at Starship Children’s Hospital and Professor at the Liggins Institute. Co leader of gut bugs research team. We explore antibiotic use in children, the impact of antibiotics on the developing microbiome, and practical strategies for clinicians to prescribe appropriately while supporting long-term child health. Antibiotics are one of medicine’s most important discoveries, dramatically reducing deaths from infectious diseases. However, widespread and sometimes unnecessary use, particularly in children has raised concerns. Emerging evidence suggests antibiotic exposure may be contributing to shifts in the epidemiology of chronic and autoimmune diseases that cannot be explained by population changes alone. **Practical clinical pearls:** 1. Antibiotics continue to be overused in infants and young children in New Zealand, although prescribing trends are improving. When antibiotics are needed, choose the narrowest-spectrum antibiotic for the shortest effective duration. 2. Early antibiotic exposure alters the gut microbiome. Observational studies have linked this with higher rates of childhood obesity, allergic disease including asthma and eczema, type 1 diabetes, and even later mental health conditions such as depression and anorexia nervosa. 3. Breastfeeding remains the gold standard for healthy microbiome development. Encourage exclusive breastfeeding for around six months where possible, as this supports immune development and microbial diversity. 4. When infants require formula feeding, consider formulas containing human milk oligosaccharides (HMOs), which may help support a healthier gut microbiome more similar to that seen in breastfed infants. 5. Diet matters once solids are introduced. Encouraging a “rainbow” of fruits and vegetables, alongside lean meats and high-fibre foods, helps promote microbiome diversity. For families in Auckland whose child requires antibiotics, consider referral to Professor Wayne Cutfield’s ongoing clinical trial investigating HMOs versus placebo following antibiotic exposure in early life. See the study link in the podcast bio. **Bio:** Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85. **Resources:** Hindson J. Post-antibiotics microbiome restoration driven by diet. *Nat Rev Gastroenterol Hepatol*. 2025;22:462. doi:10.1038/s41575-025-01090-8. Lizumi T, Battaglia T, Ruiz V, Perez-Perez GI. Gut microbiome and antibiotics. *Arch Med Res*. 2017;48(8):727–734. doi:10.1016/j.arcmed.2017.11.004. Professor Cutfeilds antibiotic study. https://www.auckland.ac.nz/en/liggins/in-the-community/clinical-studies/clinical-studies-babies-children/oak-study.html **Listen here:**